Complication Of Appendectomy Research Articles

Association of Wearable Derived Pulse Rate Variability With Pediatric Appendectomy Complications

IntroductionPostoperative recovery of children is difficult to gauge by parents after hospital discharge. Consumer wearable devices (CWD) generate valid and near real-time pulse rate data, integer pulse rate variability (PRVi), that can serve as digital biomarkers for the onset of complications during post-discharge recovery. This study sought to explore whether pediatric patients with surgical complications after appendectomy exhibited a CWD-derived PRVi trajectory that differs from the normative PRVi recovery trajectory. MethodsIn this retrospective analysis, children aged 3–17 undergoing appendectomy for complicated appendicitis was invited to participate. Participants wore a Fitbit device for 21 days postoperatively. PRVi was calculated as the variance, defined as the sum of the squared differences of each value from the mean, of the heart rate in beats per minute measured over 5 consecutive minutes. The mean daily PRVi was calculated for patients recovering with and without complications. ResultsNinety-eight patients were enrolled in the study; 60 (61 %) were ages 3–11, 54 (55 %) were female, and 57 (58 %) were Caucasian. Eleven (11 %) developed surgical complications. Those with complications experienced a slower increase in the mean PRVi over the 21-day period. ConclusionsIn this prospective observational study, it was demonstrated that PRVi derived from CWD data can be used as an objective digital biomarker to profile surgical complications. This finding provides clinicians with an additional tool for monitoring children during the postoperative period, enhancing their ability to proactively detect and address complications. Level of EvidenceIV.

Vascular complications during appendectomy: severe adhesion of the appendix to the right iliac artery: a case report

IntroductionAppendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage.Case presentationA 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis.ConclusionThis case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios.

Uncomplicated appendicitis at Herat Regional Hospital: limited resource is not always the end of the world.

Acute appendicitis is the most common aetiology of acute abdomen in children. Our aim is to describe the accuracy of diagnosis, and complications in a limited resources setting in children between 5 and 14 years old at the only tertiary referral hospital in the West region of Afghanistan. A retrospective study for a period of 1 year (21 March 2015-20 March 2016). Data was collected from patients' files. Data were analysed by epi info 7. We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5-14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra-abdominal abscesses (5%). Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments.

Stump Appendicitis: A Rare Late Complication of Appendectomy, a Retrospective Analysis of 9082 Appendectomy Cases

Objective: Appendectomy for appendicitis is one of the most common surgical procedures performed worldwide. The remnant of the appendix stump after the first appendectomy carries the risk of developing stump appendicitis. Stump appendicitis is a rare late complication of appendectomy; inflammation occurs in the remaining appendicular stump. Delayed diagnosis of this condition can cause serious complications. Stump appendicitis is indeed a recognized clinical picture, but is often overlooked when evaluating patients with right lower quadrant abdominal pain, especially those with a history of appendectomy. It remains a clinical challenge because of its often delayed diagnosis and effective treatment, and possible accompanying morbidity or mortality. Material and Methods: Materials and Methods: We retrospectively screened the patients who were hospitalized in our general surgery clinic and diagnosed with stump appendicitis in the hospital for 12 years. There were 11 patients between January 2011 and 2023 Results: The mean age of all 11 patients described was 55 years (range: 20 to 66). 72% of the patients were male (8/11 males and 3/11 females). 63% of the patients had their first operations open, and 36% of them were laparoscopic. The mean white blood cell count on presentation of all reported 11 cases was 11,996 cells/mm3 (range: 5930 to 18,740), the mean fever was 37.82°C (range: 36.8 to 38.6), and the mean CRP count on presentation of all cases was 36.7 (range: 0.4 to 142.91). The most commonly performed radiographic examination used to diagnose stump appendicitis is the abdominal computerized tomography (CT) scan. It was used in 100% (11 cases). Ultrasound was also used in 100% (11 cases). Conclusion: The appendicular base must be accessed prior to undertaking an appendectomy, irrespective of the chosen strategy or technique. It is noteworthy that, apart from open or laparoscopic appendectomy, antibiotic therapy should also be considered as part of the treatment regimen, as documented in the literature series.

314 Isolated Tuberculosis of Appendix: A Case Report

Abstract Introduction Stump appendicitis is a rare and delayed complication of appendectomy. In India, abdominal tuberculosis (TB) represents about 10% of the extra pulmonary TB and the appendix is involved in only about 1%. A combined occurrence of both conditions is very rare. Case Presentation A 24-year-old male presented to the General Surgery outpatients’ clinic with a 2-week history of right iliac fossa pain with no other associated symptoms. The patient had undergone an open appendectomy for perforated appendicitis 3 months prior to the current presentation. Per abdominal examination showed tenderness at the McBurney’s point. A CT abdomen revealed thickened and enhanced stump appendix along with adjacent fat stranding and multiple mesenteric nodes, suggestive of stump appendicitis. In light of the upward trend seen in white blood cell count, the patient was planned for a diagnostic laparoscopy and pre-anesthesia clearance was obtained. Intra-operatively, adhesiolysis of dense bowel and omental adhesions were performed. About 3.5 cm appendicular stump was resected. Micro-nodular peritoneal nodules were resected. The specimens were sent for histo-pathology examination. Results The postoperative period was uneventful with symptomatic relief. The biopsy of the stump described morphological features of caseating granulomatous inflammation, suggesting the possibility of tuberculosis while the peritoneal nodules showed infiltration of inflammatory cells. The patient was started on specific anti-tubercular treatment. Conclusions Appendicular TB is rare and of uncertain physiopathological etiology. The peculiarity of our case was the finding of abdominal TB presented as stump appendicitis. This may even be the first report with similar findings.

Risk Factors for Post-appendectomy Surgical Site Infection in Laparoscopy and Laparotomy - Retrospective Cohort Study.

Background Appendicitis is a frequent emergency condition. Surgical site infections (SSI) are a common complication of appendectomy. Despite improvements in infection control, SSIs continue to cause harm, prolonged hospital stays, and even death. Objective The objective of this study is to compare the risk of developing surgical site infections (SSIs) between open laparotomy and laparoscopic appendectomies in Al-Baha, Saudi Arabia. Methods This retrospective cohort study compared laparotomy and laparoscopy for post-operative surgical site infection among patients who underwent an appendectomy at King Fahad Hospital (KFH) in Albaha, Saudi Arabia. Medical record numbers (MRNs) of patients who met the inclusion criteria were collected to build the sampling frame. From the final sampling frame, simple random sampling using a random number generator was used to draw a representative sample. Data were collected from the surgical health records of the patients. The collected data included patients' demographics, comorbidities, presenting symptoms, ordered imaging studies, pre-operative shaving, typeand duration of surgery, intraoperative findings, and signs of wound inflammation. Results The total number of patients included in the analysis was 256, who underwent surgery for acute appendicitis. Among those who underwent laparoscopy, 5.7% had to be converted to open laparotomy. Signs of surgical wound inflammation were found in 10.2% of the patients. Patients who underwent open laparotomy had a significantly higher risk of wound infection (RR=3.1, p-value=0.001). Further analysis revealed an effect modification of pre-operative shaving. Open laparotomy has a higher risk of wound infection among patients who have not had pre-operative shaving (RR=4.1 vs. RR=2.6), while both risks were statistically significant (p-value=0.033 and p-value=0.035), respectively. Complicated cases in intra-operative findings were found to have a higher risk of post-appendectomy SSI. Conclusion This study demonstrates that laparoscopic appendectomy carries a lower risk of surgical site infection (SSI) compared to open laparotomy. Additionally, pre-operative shaving of the surgical site was found to increase the incidence of SSI. Healthcare providers can use this information to enhance their practice and reduce the occurrence of surgical site infections. Whenever possible, laparoscopic appendectomy should be preferred over open laparotomy due to its substantially lower SSI risk. We also recommend vigilant monitoring of complicated appendectomy, particularly in cases of ruptured appendicitis, for signs of SSI.

ENTEROCUTANEOUS FECAL FISTULA FOLLOWING OPEN APPENDECTOMY: A CASE REPORT AND REVIEW OF LITERATURE

Appendiceal fecal stula is a well-known rare serious but very rare complication of appendectomy, which is one of the most common surgical procedures performed in general surgical practice. Fecal stula is distressing for both the surgeon as well as the patient. We are reporting here a case of a 50 years old man with a post-appendectomy fecal stula which was successfully treated conservatively

Stump appendicitis: challenging diagnosis with serious complication: a case report

Stump appendicitis is a rare complication of appendectomy because of recurrent inflammation of the residual appendix. The diagnosis is often delayed because of low index of suspicious, which may result in serious complications. Twenty-three-year-old male patient presented with right lower quadrant abdominal pain after 7month of appendectomy done at a hospital. On physical examination, he has right lower quadrant tenderness and rebound tenderness. Abdominal ultrasound was done with finding of blind-ended tubular noncompressible 2cm long part of appendix with wall-to-wall diameter of 10mm. There is also focal defect with surrounding fluid collection. With this finding, perforated stump appendicitis was diagnosed. He was operated with similar intra operative finding. The patient discharged improved after 5days of hospital. This is first reported case in Ethiopia as far as our search is concerned. Despite past medical history of appendectomy, the diagnosis was made by means of ultrasound scan. Stump appendicitis is a rare but important complication of appendectomy, often misdiagnosed. Prompt recognition is important to avoid serious complications. This pathologic entity should always be kept in mind in case of right lower quadrant pain in patient with previous history of appendectomy.

Postoperative Complications of Appendectomy in Gynecologic Laparoscopic Surgery for Benign Indications.

To assess whether concomitant appendectomy in patients who undergo laparoscopic surgery for benign gynecologic indications is associated with increased rates of complications in the 30-day postoperative period. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent laparoscopic surgery by a gynecologist. Patients were excluded if they underwent open abdominal surgeries, bowel resections, urogynecologic surgeries, or if diagnoses of cancer or appendicitis were present. There were 246,987 patients included in the population cohort from 2010 to 2020. Demographic information and postoperative outcomes of patients who underwent concomitant appendectomy were compared with patients who did not undergo appendectomy. A matched cohort was created by computing propensity scores, and outcomes were again compared between groups. All patients undergoing appendectomy were 1:1 matched to a unique patient who did not undergo appendectomy using a greedy matching based on the propensity score calculated from demographic and surgical characteristics. A total of 1,760 patients (0.7%) underwent concomitant appendectomy. There was an 8.0% complication rate in the appendectomy group, compared with 5.5% in the group of those without appendectomy (P<.001), and this was similar to the results in the propensity-matched sample. Patients who underwent appendectomy had significantly higher rates of readmission (4.3% vs 2.3%), which remained significant in the propensity-matched sample. There were no differences in the rates of postoperative thromboembolic events, blood transfusion, or reoperation. Patients who are undergoing concomitant appendectomy have an increased risk of any complication and hospital readmission. Additional studies may be conducted to identify patients with optimal risk benefit profiles when considering performing concomitant appendectomy at time of gynecologic surgery.

Evaluation of Clinical and Paraclinical Findings in Cases of Pregnancy Appendectomy in Ali Ebn-e Abitaleb Hospital Within 2015 - 2019

Background: Abdominal pain is one of the most common complaints during pregnancy and is always debated due to its numerous differential diagnoses. Acute appendicitis is the most common complication requiring surgery during pregnancy. Objectives: The present study aimed to investigate symptoms, signs, and paraclinical findings in cases of pregnancy appendectomy within 2015 - 2019. Methods: This retrospective study examined the frequency of appendectomy in pregnant women referring to Ali ibn Abi Talib Hospital of Zahedan in Iran. This study assessed 58 pregnant women who referred to Ali Ebne-e Abitaleb hospital and underwent appendectomy from April 2015 to March 2019. Finally, the data were evaluated in terms of age, gravidity, gestational age, body temperature, clinical symptoms, complications of appendectomy, type of surgery, and white blood cells (neutrophil). For data analysis, the information was entered into SPSS software (version 22). Results: In the present study, the most common symptoms and signs of patients were tenderness and right lower quadrant (RLQ) pain (87.93%), nausea (75.9%), leukocytosis (72.4%), migration of pain (65.5%), vomiting (58.6%), and anorexia (53.4%). Additionally, the most common appendicitis trimester for appendicitis in pregnancy was the second thermistor (62.1%). Conclusions: Tenderness in the RLQ area was the most important feature of appendicitis; however, nausea and leukocytosis were also common. Ultrasound was not a powerful imaging method due to the identification of less than half of the patients; nevertheless, the Alvarado score for acute appendicitis was helpful in numerous cases.

7542 Post-Operative Complications of Appendectomy in Benign Gynecologic Surgery: National Surgical Quality Improvement Program Analysis

<h3>Study Objective</h3> This study was conducted to assess if concomitant appendectomy in women undergoing laparoscopic surgery for benign gynecologic indications is associated with increased rates of post-operative complications in the 30-day post-operative period. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> National database study. <h3>Patients or Participants</h3> American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was utilized to identify women who underwent laparoscopic surgery by a gynecologist. Patients were excluded if they underwent open abdominal surgeries, bowel resections, urogynecologic surgeries, or if cancer or appendicitis was present. There were 247,700 patients included in population cohort between 2010 and 2020. <h3>Interventions</h3> Patients were identified using Current Procedural Terminology codes. Patients who underwent concomitant appendectomy were compared to patients who did not undergo appendectomy. Demographic variables included age, body mass index, and medical co-morbidities. Post-operative complications included superficial, deep, or organ space infection, sepsis, thromboembolic events, blood transfusion, hospital re-admission, and re-operation. A matched cohort was created by computing propensity scores. Outcomes were compared between groups using Fisher and Mann-Whitney tests. <h3>Measurements and Main Results</h3> 1,815 patients (0.7%) underwent concomitant appendectomy. In the propensity matched sample, there were comparable rates of post-operative surgical site infections at 2.8% in the appendectomy group and 2.4% in the no appendectomy group (p-value 0.469). There were higher rates of sepsis in the appendectomy group with 1.3% of patients being diagnosed with sepsis compared to 0.3% in the no appendectomy group (p-value 0.003). There were higher rates of hospital re-admission in the appendectomy group at 4% compared to 3% in the no appendectomy group (p-value 0.006). There were no differences in the rates of post-operative thromboembolic events, blood transfusion, or re-operation. <h3>Conclusion</h3> Patients undergoing concomitant appendectomy at the time of benign gynecologic laparoscopic surgery have increased risk of post-operative sepsis and hospital re-admission. Additional studies may be conducted to identify patients with optimal risk-benefit profiles when considering concomitant appendectomy.

Role of Conservative Management in Stump Appendicitis: A Case Series.

Stump appendicitis is a rare, delayed complication of appendectomy. It is seen following both open and laparoscopic appendectomy and may occur weeks to years following the initial appendectomy. We report two cases of stump appendicitis seen at our hospital. Both cases were diagnosed based on radiological findings and successfully managed conservatively with antibiotics. Although the usually recommended treatment for stump appendicitis is completion appendectomy, conservative management may be suitable for some patients. This report highlights the possibility of utilizing a conservative approach in the management of stump appendicitis compared to the recommended operative intervention. Awareness of the possibility of stump appendicitis is crucial for early diagnosis and treatment, to prevent potentially catastrophic complications.

Clostridioides difficile infection after appendectomy: An analysis of short-term outcomes from the NSQIP database

BackgroundClostridioides difficile infection can be a significant complication in surgical patients. The purpose of this study was to describe the incidence and impact on outcomes of Clostridioides difficile infection in adult patients after appendectomy. MethodsThe American College of Surgeons National Surgical Quality Improvement Program data set was used to identify all patients with the primary procedure code of appendectomy between 2016 and 2018. Patient demographics and clinical characteristics were extracted from the database, and descriptive statistics were performed. A multivariate logistic regression was created to identify predictors of Clostridioides difficile infection following appendectomy. ResultsA total of 135,272 patients who underwent appendectomy were identified, and of those, 469(0.35%) developed Clostridioides difficile infection. Patients with Clostridioides difficile infection were more likely to be older (51.23 vs 40.47 years; P < .0001), female (P = .004), American Society of Anesthesiology score >2 (P < .0001), present with septic shock (P < .0001), or lack functional independence (P < .0001). Patients with Clostridioides difficile infection were more likely to have increased operative time (62.9 vs 50.4 minutes; P < .0001), have perforated appendicitis (48.9% vs 23.5%; P < .0001), and underwent open surgery (7.0% vs 4.0%; P = .0006). Postoperatively, patients with Clostridioides difficile infection required a longer length of stay (4.8 vs 1.8 days; P < .0001), had increased mortality (2.1% vs 0.1%; P < .0001), higher incidences of postoperative abscess (14.9% vs 2.9%; P < .0001), postoperative sepsis (15.1% vs 4.0%; P < .0001), and readmission (30.7% vs 3.4%; all P < .0001). On multivariate analysis, older age (P < .0001), female sex (P = .0043), septic shock (P = .0002), open surgery (P = .037), and dirty wound class (P = .0147) were all independently predictive factors of Clostridioides difficile infection after appendectomy. ConclusionClostridioides difficile infection is an uncommon postoperative complication of appendectomy and is associated with worse outcomes and higher mortality. Older patients, female sex, those with sepsis, and those undergoing open surgery are at higher risk for developing Clostridioides difficile infection.

Complications after appendectomy in patients with treated appendicitis: results from a retrospective study

This study was designed to provide additional insights into the incidence of appendectomy complications in patients with appendicitis. A total of 619 patients who underwent appendectomy for appendicitis between 2014 and 2020 were recruited. Preoperative patient data and details of postoperative complications were collected. Comparisons between simple and complex appendicitis were obtained via univariate and multivariate analyses of the outcomes. Simple and complex appendicitis was diagnosed in 192 and 427 patients, respectively. Twenty-eight patients with simple appendicitis developed complications, and 14 of these were infectious complications. In patients with complex appendicitis, 65 patients developed complications, and 55 of these were infectious complications. Infectious complications were identified as the largest proportion of complications. The significant risk factor for infectious complications in simple appendicitis was American Society of Anesthesiologists (ASA) grade [odds ratio (OR) =7.843, 95% confidence interval (CI): 1.987-30.955, P=0.003]. ASA grade (OR =1.992, P=0.032) and positive bacterial culture (OR =4.019, 95% CI: 1.809-8.933, P=0.001) were significantly related to infectious complication in complex appendicitis. This study showed that appendectomy is not always a routine operation with few complications. There was a relatively high rate of complications in patients with appendicitis, which were mostly infectious complications. A higher ASA grade correlated with infectious complication. In some cases of complex appendicitis, patients with positive bacterial culture may have had a greater risk of infectious complications.

Stump appendicitis - a systematic analysis.

&lt;b&gt;Aim:&lt;/b&gt; The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general surgical procedure conducted in the world. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Methods:&lt;/b&gt; 48 cases included from 36 articles published in the peer reviewed journals of repute were evaluated for eight variables including: (I) age of the patient, (II) gender, (III]) duration of symptoms, (IV) imaging, (V) interval time since initial operation, (VI) details of initial operation, (VII) management, (VIII) stump length if managed by operation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Results:&lt;/b&gt; 48 cases (27 males and 19 females) ranging in age from 2 to 72 years reported after a wide range of time (3 days - 46 years) after primary appendectomy. The duration of symptoms ranged from 1 day to 7 months. As many as 31 (64.5%) cases had inflamed stump appendix whereas 17 (33.5%) had perforation. Twenty-one (43.7%) had undergone laparoscopic primary appendectomy and 27 (56.3%) had undergone open appendectomy. Management of the retained stump included stump appendectomy in 42 (87.5%), right hemicolectomy in 2 (4.2%) and conservative in 4 (8.3%) cases. In the 44 cases managed by surgical intervention, the approach was open in 27 (61.4%) and laparoscopic in 17 (38.6%) cases. The length of the retained appendix stump ranged from 0.5 cm to 6.5 cm (mean 2.14 cm). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Stump appendicitis is an entity that a physician needs to suspect if a patient reports with features of appendicitis even after appendectomy had been conducted. Management is generally surgical and aimed at removal of the retained appendiceal stump.

Economic Trends of Racial Disparities in Pediatric Postappendectomy Complications.

Despite unparalleled advances in perioperative medicine, surgical outcomes remain poor for racial minority patients relative to their white counterparts. Little is known about the excess costs to the health care system related to these disparities. We performed a retrospective analysis of data from the Nationwide Inpatient Sample between 2001 and 2018. We included children younger than 18 years admitted with appendicitis who underwent an appendectomy during their hospital stay. We examined the inflation-adjusted hospital costs attributable to the racial disparities in surgical complications and perforation status, focusing on differences between non-Hispanic white patients and non-Hispanic Black patients. We included 100 639 children who underwent appendectomy, of whom 89.9% were non-Hispanic white and 10.1% were non-Hispanic Black. Irrespective of perforation status at presentation, surgical complications were consistently higher for Black compared with white children, with no evidence of narrowing of the racial disparity gap over time. Black children consistently incurred higher hospital costs (median difference: $629 [95% confidence interval: $500-$758; P < .01). The total inflation-adjusted hospital costs for Black children were $518 658 984, and $59 372 044 (11.41%) represented the excess because of the racial disparities in perforation rates. Although all patients had a progressive decline in post appendectomy complications, Black children consistently had higher rates of complications and perforation, imposing a significant economic burden. We provide an empirical economic argument for sustained efforts to reduce racial disparities in pediatric surgical outcomes, notwithstanding that eliminating these disparities is simply the right thing to do.

Is a single dose of prophylactic antibiotics sufficient in patients with acute noncomplicated appendicitis

Background Antibiotics prescription before surgery is considered to be effective in reducing the infectious complications of appendectomy. As a result, most surgeons prescribe antibiotics before surgery for patients diagnosed with appendicitis. Objective The aim of study was to evaluate the effect of a single antibiotic dose compared with the concurrent regimen on the outcome of appendectomy, especially infective complications. Patients and methods A total of 60 cases diagnosed with appendicitis were included, and they were divided into two groups: group A (single dose of cefotaxime 1 g and metronidazole 500 mg before surgery) and group B (the same regimen was received, and it was repeated twice daily for 4 days). All cases were subjected to history taking, physical examination, and routine investigations. At follow-up, all cases were clinically assessed. Results There were no significant statistical differences between groups in age, sex, and BMI variables. No significant statistical differences were observed during the surgery and hospitalization period between two groups. Wound infection occurred in 10 and 6.67% of cases in both groups, respectively (P > 0.05). However, the cost was significantly higher in group B. Conclusion A single dose preoperative antibiotics appears to be as efficacious as concurrent regimen in preventing wound infections after appendectomy. Continuing antibiotic prophylaxis in the postoperative period was not necessary, and it added additional unnecessary financial costs.

POST-OPERATIVE ORAL ANTIBIOTICS IN REDUCING FREQUENCY OF SURGICAL SITE INFECTION FOLLOWING NON-PERFORATED APPENDECTOMY IN POPULATION OF SOUTH WAZIRISTAN AGENCY, PAKISTAN

Background: Acute appendicitis is most frequent cause of acute abdomen in younger population, and surgical site infection (SSI) is commonest complication of appendectomy. The objective of this trial was to compare the efficacy of post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan.Materials Methods: The randomized placebo trial was conducted at Agency Headquarter Hospital, Wana, South Waziristan, Pakistan from October 1, 2016 to November 18, 2018. One hundred fifty (150) patients were randomly allocated into two groups, 75 in experimental group, to whom antibiotics were given and 75 in placebo group, to whom antibiotics were not given. Age groups and presence of SSI were two variables, being on nominal scale, were described by count and percentage with CI at 80%CL. McNemar chi-square test was applied to test the hypothesis to see the significance of difference between the experimental and placebo groups in terms of frequency of SSI at alpha .05.Results: SSI was present in nine (12%, 80%CI 7.19-16.80%) out of 75 cases in experimental group and in 12 (16%, 80%CI 10.57-21.42%) out of 75 cases in placebo group. McNemar chi-square test showed no significant difference between the experimental and placebo groups in terms of frequency of SSI (p=.2482).Conclusion: The results are comparable for post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan.

A STATISTICAL ANALYSIS OF WOMEN’S REPRODUCTIVE HEALTH CHARACTERISTICS AFTER INEFFECTIVE REATTEMPTS OF USING ART

The aim: To carry out a statistical analysis of physical and reproductive health characteristics in women after ineffective reattempts of using assisted reproductive technologies and identify significant medical and social factors contributing to the development of chronic endometritis. Materials and methods: We carried out a statistical analysis involving 177 outpatient medical records: group 1 includes 127 women aged under 45 with two or more ineffective attempts of in vitro fertilization; group 2 comprised 50 healthy women without reproductive disorders. The complete physical exam included past history, clinical and gynecologic examination, lab techniques and medical imaging according to outpatient medical records obtained during the follow-up care in Isida-IVF Medical Center LLC. Chronic endometritis was recognized by means of histologic examination of endometrium, with the samples obtained by an endometrial pipelle biopsy on day 4-9 of the menstrual cycle. Results: The prevalence of pelvic inflammatory disease in patients of group 1 comprised 47.2%, endometritis - 41.7%; p1.2 <0.01. The prevalence of acute endometritis among patients of group 1 comprised 6.3%; p1.2 >0.05 and was associated with an infection after abortion. In group 1, sexually transmitted infections were reported in 67.7% of patients, p1.2> 0.05, bacterial vaginosis was registered 1.5 times more often - 28.4%; p1.2 <0.05. In group 1, single induced abortion was reported in 15.0%, while 2 times it took place in 15.7% (p1.2 <0.05). Laparoscopies were previously performed in 59.8% of women, laparotomies - in 62.2%, while in 25.4% of women these interventions were reperformed. Unilateral salpingectomy, due to ectopic pregnancy, was performed in 25.4% of women, bilateral - in 12.7%. Fallopian tube removal, due to sactosalpinx, was performed in 25.4% of women, unilateral salpingectomy took place in 3.9% of cases. The most significant risk factors of chronic endometritis in groups studied are acute postabortal endometritis, RR (relative risk) = 1.439, p = 0.029 and postoperative peritonitis provoked by the complications of appendectomy, RR = 1.430, p = 0.084. We detected none of significant effects of pelvic inflammatory disease on the development of chronic endometritis (RR = 45.132, Confidence interval (CI) (6.151-331.167), p = 0.001). The analysis of reproductive failures, as a risk factor of chronic endometritis in women of group 1, showed a significant relative risk: with the past history of premature birth, RR = 1.44, p = 0.039, in case of reattempts of induced abortions, RR = 1.5, p<0.001, Spontaneous miscarriage RR = 1.572, p = 0.001. A higher relative risk of developing chronic endometritis was observed during pregnancy - RR = 1.597, p = 0.001. Conclusions: Statistical analysis of women's reproductive health after ineffective reattempts of using ART revealed that the high rate of fetal interventions, low rate of alternative and safe abortion methods are registered in these women, as well as the nonavailability of any system of health measures after reproductive failures. A significant increase in miscarriage at early stages takes place, as well as the absence of a tendency for preterm labor to decrease in the rate. Maintaining women's reproductive health is a considerable medical and social issue, whose resolving depends on joint efforts of governmental and public entities, healthcare agencies and the population responsibility for own health. Designing and adopting the program of preconception care and planning for pregnancy in women after ineffective reattempts of using ART, with chronic endometritis as a primary disease, should be the top priority area of a health care system.

Re-laparoscopy for the treatment of complications after laparoscopic appendectomy: is it possible to maintain the minimally invasive approach?

Despite laparoscopy is considered an adequate tool for the diagnosis and management of postoperative surgical complications, its role after laparoscopic appendectomy (LA) remains uncertain. The aim of this study was to evaluate whether laparoscopy is useful for treating complications after laparoscopic appendectomy. A retrospective analysis of a prospectively collected database of patients undergoing LA, who needed a reoperation for postoperative complications during the period 2006-2020, was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A total of 2019 LA were performed, and 41 patients (2%) underwent a RL for post appendectomy complications. Twenty-three patients (56%) were male. The mean age was 32years old (16-92years). The majority of patients (75%) had a complicated acute appendicitis in the first operation. The most common findings at RL were generalized peritonitis (36.4%) and intraabdominal abscesses (26.8%). Five patients (12.1%) developed stump appendicitis, all of them as a late complication. The procedures were completed laparoscopically in 85% and 6 patients (15%) required conversion to an open approach. Three patients (7.3%) required a percutaneous drainage and two patients (4.9%) needed an additional surgery (laparotomy) after RL, all of them presenting with generalized peritonitis at the RL. No mortality was registered. Re-laparoscopy is feasible, safe, and highly effective for the diagnosis and treatment of post appendectomy complications. RL should be encouraged to avoid more aggressive procedures.